Informatics Interoperability Not Prioritized by Vendors

Perhaps one of the most staggering aspects of the cardiology informatics exhibits on the European Society of Cardiology (ESC) Congress 2014 show floor, was the level of “openness” presented by the various vendors for their cardiology image and information management systems (i.e., C-PACS, CVIS). This seems quite peculiar for someone more used to the radiology informatics markets stateside and almost an aberration considering the competitive practices the U.S. market is used to.

This is in sharp contrast with the American College of Cardiology (ACC) 2014 Annual Scientific Session exhibit floor, and for someone more used to the imaging informatics markets stateside, the vendors exhibiting at the ESC Congress 2014 seem to be much more proactive in showcasing their portfolio of integrations with third-party vendor plugins, while demonstrating these external modules as part of their own integrated offering.

In fact, it seems that in European cardiology informatics, more than in any other industry, a truly open, yet closely integrated multi-vendor software platform is a critical requisite for customers and obligation for vendors.  While it is widely acknowledged that a similar approach could bring tremendous improvements not only to cardiology but also to radiology informatics, in the U.S., vendors, for the most part, have not gone that route.

Market Fragmentation Imposing Multi-Vendor Rules to the Game
The high degree of fragmentation in the European cardiology informatics market might be one of the factors that has underlined the somewhat integrated multi-vendor environment that characterizes the current market and product offerings.[[{"type":"media","view_mode":"media_crop","fid":"27729","attributes":{"alt":"Nadim Michel Daher","class":"media-image media-image-right","id":"media_crop_1852224191931","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2737","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 188px; width: 150px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Over the years, different language requirements by country or region, for example, have led to the emergence of strong local players in cardiology informatics across Europe, along with pronounced user preferences for particular vendors and products.

Indeed, other than in Poland where an English platform might be acceptable, regulatory bodies in virtually every other country in Europe impose the use of the local language for clinical information systems, posing an entry barrier to many vendors.

Several local software vendors have traditionally catered to individual sub-segments of the cardiovascular imaging spectrum. Their core competency revolves around specific functions like image management, information management and reporting for specific types of procedures (e.g., the echocardiography “echo” lab, the catheterization “cath” lab, electrophysiology, etc.), thus adding layers of market complexity to the overall cardiology IT industry.   

Making for a Challenging Growth Environment for Vendors
The high degree of fragmentation might explain why even the large, global cardiology imaging market leaders (i.e., Philips Healthcare, GE Healthcare and Siemens Healthcare) typically have a physical presence and a dedicated cardiology informatics salesforce in only three or four carefully-selected European countries or geographies, while addressing opportunities in other countries on an ad hoc basis or through their local distributors.

The same holds true for most of the key local players. German-based TomTec Imaging Systems and VISUS, Italy-based Esaote and Medimatic, or France-based Medireport, who, even though were born and bred in Europe, do not have the Europe-wide spread that similar companies would typically have in the U.S. market after several years of operation.

Fragmentation might also be part of the reason why some other important global market players in cardiology informatics, such as Fujifilm Medical, Agfa HealthCare, McKesson or Merge Healthcare did not have their own booth at the ESC Congress 2014 this year. This is despite the fact, for example, that Agfa HealthCare is the leader in the German cardiology informatics market - the second largest market opportunity after the United Kingdom - or the fact that McKesson is experiencing significant traction in the U.K./Ireland market.

This emphasizes a simpler but perhaps just-as-valid rationale for the limited representation of the global cardiology informatics industry at the ESC Congress – that traditionally, the Congress has not been known for being a major lead-generating and money-making show for vendors, unlike, for example, the RSNA Annual Meeting for radiology or the ACC Annual Scientific Session for cardiology.

As such, the current slow-growth economic context prevailing in various European countries and the region in general may have discouraged potential exhibitors from moving forward with their participation at ESC Congress 2014.

Benefiting Customers Seeking a Best-of-Breed Application Ecosystem
It seems to be part of the European cardiology market culture that customers dictate the list of third-party applications they wish to use for each procedure or workflow step to their primary vendor. Whether the vendor achieves these user requirements through basic application-level integration such as a digital imaging and communications in medicine (DICOM)-level connection, through component-level integration, or through a deeper, algorithm-level integration, does not strictly matter as long as customer preferences are ultimately met.

The comparison between the vendors’ attitude in the U.S. and in Europe makes it clear that systems integration and interoperability in imaging informatics, or the lack thereof, owe much more to the vendors’ collective attitude and their go-to-market approach than it does to technology. This applies not only to cardiology informatics, but radiology informatics as well. Therefore, by being more demanding in their requests for proposal and through their negotiations with vendors, U.S. customers can expect to achieve the integrated, best-of-breed, multi-vendor environment they aspire to, while still being able to deal with a single primary vendor.